内镜联合特利加压素或生长抑素治疗食管胃静脉曲张出血的效果观察  

Efficacy of endoscopy combined with terlipressin or somatostatin for esophageal gastric varices bleeding

作　　者：马雪梅 楚金东 任辉 吴勤 张文辉 申力军 王艳玲 刘博 毕茜 吴立兵 迟春生 闫丽萍 刘自帅 于晓莉 路筝 金波 MA Xue-mei;CHU Jin-dong;REN Hui;WU Qin;ZHANG Wen-hui;SHEN Li-jun;WANG Yan-ling;LIU Bo;BI Qian;WU Li-bing;CHI Chun-sheng;YAN Li-ping;LIU Zi-shuai;YU Xiao-li;LU Zheng;JIN Bo(Department of Hepatology,Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]中国人民解放军总医院第五医学中心肝病医学部,北京100039

出　　处：《传染病信息》2021年第2期136-139,共4页Infectious Disease Information

基　　金：北京市自然科学基金资助项目(7192201);吴阶平医学基金会临床科研专项资助基金(320.6750.12337)。

摘　　要：目的观察内镜联合特利加压素或生长抑素治疗食管胃静脉曲张出血(esophageal gastric varices bleeding,EGVB)的效果。方法回顾性分析我院2015年1月—2018年5月因肝硬化EGVB并给予急诊内镜下硬化治疗或组织粘合剂栓塞治疗的患者128例,分别给予特利加压素和生长抑素治疗,据此分为特利加压素治疗组(n=80)和生长抑素治疗组(n=48)。在急诊胃镜治疗后24 h行第2次内镜复查,观察2组的24 h止血率、6周病死率、粪便转黄时间、粪便潜血转阴时间以及并发症的发生情况。结果2组患者在24 h止血率、粪便转黄时间、粪便潜血转阴时间等方面比较,特利加压素组均优于生长抑素组,差异均有统计学意义(P均<0.05);而2组患者在6周病死率、并发症的发生等方面相比,差异均无统计学意义(P均>0.05)。结论血管活性药物联合内镜治疗是EGVB有效的止血措施,止血24 h复查内镜可以准确判断EGVB控制与否,并可及时给予再次内镜治疗。特利加压素联合内镜治疗可以更快控制急性EGVB,有利于更早进行EGVB二级预防治疗。Objective To determine the efficacy of endoscopy combined with terlipressin or somatostatin for esophageal gastric varices bleeding(EGVB).Methods A retrospective analysis was performed among 128 patients with EGVB due to cirrhosis who underwent emergency endoscopic sclerotherapy or tissue adhesive embolization therapy from January 2015 to May 2018 in our hospital.The patients were accordingly divided into the terlipressin treatment group(n=80)and the somatostatin treatment group(n=48).The second endoscopy re-examination was performed at 24 hours after emergency gastroscopic therapy,to observe the 24-hour haemostatic success rate,6-week mortality rate,time until the stool colour turned yellow,time until the faecal occult blood test became negative and complications of 2 groups.Results There were significant differences in the 24-hour haemostatic success rate,time until the stool colour turned yellow,and time until the faecal occult blood test became negative(all P<0.05),and the terlipressin group was superior to the somatostatin group in terms of those three outcomes.However,there were no significant differences in 6-week mortality rate or complications between 2 groups(P>0.05).Conclusions Cardiovascular active drugs combined with endoscopic therapy are an effective haemostatic measure for EGVB.Endoscopy re-examination at 24 hours after haemostatic therapy can accurately determine whether EGVB is controlled and require secondary endoscopic therapy in a timely manner as appropriate.Terlipressin combined with endoscopic therapy can control acute EGVB more quickly,which is conductive to earlier secondary prophylaxis of EGVB.

关 键 词：特利加压素 生长抑素 内镜硬化治疗 组织胶栓塞 食管胃静脉曲张 出血 

分 类 号：R575.2[医药卫生—消化系统]